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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561710698
Report Date: 08/05/2022
Date Signed: 08/05/2022 02:50:35 PM

Document Has Been Signed on 08/05/2022 02:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117
FACILITY NAME:HOLY CROSS FAMILY PRE-SCHOOL AND DAY CAREFACILITY NUMBER:
561710698
ADMINISTRATOR:SAMANTHA JULIASFACILITY TYPE:
840
ADDRESS:1212 MARICOPA HIGHWAYTELEPHONE:
(805) 646-8121
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY: 35TOTAL ENROLLED CHILDREN: 35CENSUS: 20DATE:
08/05/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Alex MolinaTIME COMPLETED:
12:59 PM
NARRATIVE
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On 8/5/2022 at 11:31 AM, Licensing Program Analyst (LPAs) Austin Rios conducted a Case Management inspection. LPA met with Alex Molina. LPA advised licensee the purpose of the inspection. A tour of the facility was conducted by LPA with director. The facility had twenty children in care at the time of the inspection.

On 5/17/2022 LPA Rona Chavez observed that the room that was supposed to be used for the school age was a chapel and was not being used by the school age children. School age children were using the outside only.

The following CCR, Title 22, Division 12 regulation is being cited 101179(b)(3) Capacity determination.

Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LPA Rios explained and provided appeal rights to the licensee.

One type A deficiency was cited today:

An exit interview was conducted with director.

THE NOTICE OF SITE VISIT WAS POSTED AS REQUIRED BY H&S CODE SEC. 1596.817. THE NOTICE OF SITE VISIT MUST REMAIN POSTED FOR 30 DAYS OR A CIVIL PENALTY OF $100.00 WILL APPLY
SUPERVISORS NAME: Ana Tolentino
LICENSING EVALUATOR NAME: Austin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/05/2022 02:50 PM - It Cannot Be Edited


Created By: Austin Rios On 08/05/2022 at 12:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117

FACILITY NAME: HOLY CROSS FAMILY PRE-SCHOOL AND DAY CARE
FACILITY NUMBER: 561710698

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2022
Section Cited
CCR
101538.3

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101179 Capcity Determination
(b) The number of children for which the child care center is licensed to provide care and supervision shall be determined on the basis of the Department's application review...
(3) Physical features of the child care center, including available space,...
This requirement was not met as evidence by:
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Licensee willl provide a written statement of how the facility will ensure that the indoor class will be used by and submit to LPA Rona Chavez by 8/12/2022 via email rona.chavez@dss.ca.gov
Facility will be called into licensing office for conference as well.
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Based on LPA observeation during inspection on 5/17/2022, facility was using the school age classroom as a chapel and facility was using outside space as the space for school age.

This poses an immediate risk to the health and safety of the children in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Tolentino
LICENSING EVALUATOR NAME:Austin Rios
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022


LIC809 (FAS) - (06/04)
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